Provider Demographics
NPI:1467602888
Name:MERTZ, GINA A (MFT)
Entity Type:Individual
Prefix:MISS
First Name:GINA
Middle Name:A
Last Name:MERTZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8037 FAIR OAKS BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6742
Mailing Address - Country:US
Mailing Address - Phone:916-544-9045
Mailing Address - Fax:
Practice Address - Street 1:8037 FAIR OAKS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6742
Practice Address - Country:US
Practice Address - Phone:916-544-9045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40252106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist